The Credentialing Specialist is responsible for the development, maintenance, and reporting for credentialing work as it relates to payer and facility credentialing. The specialist is responsible for direct maintenance of provider files for payer credentialing as well as maintaining credentialing software and billing systems appropriately.
Required Education: High School Diploma / GED
Required Experience: At least one (1) year of experience in a physician office or medical billing operation. Strong PC skills, including word processing and spreadsheets. Must have the ability to learn and utilize custom systems and applications. Results-oriented mindset coupled with the ability to work both collaboratively and autonomously.
Creation of initial credentialing file for providers and facilities
Submission of provider and facility paperwork/forms based on payer requirements
Communicates with providers and service lines to obtain necessary data for submission to payers
Responsible for re-certification in a timely manner for provider and facility contracts
Documents receipt of all correspondence appropriately
Updates and/or corrects provider and facility information as needed
Compile reports on inflow and outflow of credentialing tasks
May perform other duties as assigned or requested and job specification can be modified or updated at any time